Health

Effect of corticosteroids for fetal maturation on perinatal outcomes, February 28-March 2, 1994

Article Abstract:

Corticosteroids administered before delivery of a premature infant appear to safely reduce neonatal death, respiratory distress syndrome, hemorrhage, and other adverse outcomes. At its consensus development conference, the National Institutes of Health (NIH) issued a statement supporting the use of corticosteroids for fetal maturation. Controlled studies show that corticosteroids can protect infants against respiratory distress syndrome and circulatory problems, including brain injury. The corticosteroids recommended by the NIH are dexamethasone and betamethasone. Corticosteroids should be used with caution, however, in cases of premature rupture of membranes in preterm births because of the risk of sepsis. Overall, the benefits of the treatment documented in controlled studies far outweigh the risks. Although the initial treatment is costly, NIH believes that the use of corticosteroids will produce substantial cost savings because of reduction in chronic illnesses and reduced length of hospital stay.

Standards, United States. National Institutes of Health, Premature labor

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An exploration of opinion and practice patterns affecting low use of antenatal corticosteroids

Article Abstract:

A major reason why corticosteroids are used infrequently before birth in premature infants appear to involve the uncertainty of risk versus benefits. Corticosteroids aid in fetal maturation. Telephone interviews were conducted with maternal-fetal medicine specialists, neonatologists, and obstetricians. Forty-five obstetricians also participated in focus groups. Obstetricians and maternal-fetal medicine specialists tended to feel uncertain about administering corticosteroids, while almost all the neonatologists were confident that the hormones were beneficial and posed few risks. In deciding whether to administer corticosteroids, obstetricians favored deliveries that would be within 7 days but more than 48 hours, gestational age of 28 to 34 weeks, and lack of infection, pulmonary swelling, or other complications. A consensus of specific indications for use of corticosteroids was not reached among these specialists.

Practice variation in the use of corticosteroids: a comparison of eight data sets

Article Abstract:

The method of infant delivery, type of drugs used during labor, and length of gestation apparently influence the use of corticosteroids during premature labor, which promote fetal maturation. Researchers analyzed eight large data sets of more than 30,000 premature births.Corticosteroids were used more frequently when drugs that inhibit uterine contractions were also used, and for cesarean births. Physicians may use corticosteroids more often in cesarean births because they know when the births will occur and have time to administer the hormones. The use of corticosteroids among preterm births has increased from about 8% to a high of 26% from the early 1980s to the early 1990s in some clinical studies, but the usage is considered low in light of the benefits that can be derived from such treatment.